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Description

Raney et al[1] developed a Clinical Prediction Rule (CPR) for identifying patients with neck pain likely to respond to mechanical cervical traction. Eighty patients with neck pain received 6 sessions of intermittent cervical traction and cervical exercises 2x/week for 3 weeks. Outcome was measured based on the global rating of change (> ±6 were classified as having a successful outcome). Based on a significance level of P< 0.15, five variables out of 15 potential variables were retained in the final regression model.

Although a following validation study is warranted, this preliminary CPR provides the ability for a clinician to identify the sub-group of patients with neck pain who would most likely to benefit from cervical traction and exercise.

The probability of successful outcome after cervical traction is calculated using the + LR and pretest probability of 44% (30 out of 68 patients). Accuracy statistics with 95% CI for individual variables for predicting success with cervical traction.

# of predictors present

Sensitivity

Specificity

+ LR

- LR

Probability of success w/ cervical traction + exercise

> 4

0.30(0.17-0.48)

1.0(0.91-1.0)

23.1(2.25-227.90)

0.71(0.53-0.85)

94.8%

> 3

0.63(0.46-0.78)

0.87(0.73-0.94)

4.81(2.17-11.4)

0.42(0.25-0.65)

79.2%

> 2

0.30(0.17-0.48)

0.97(0.87-1.00)

1.44(1.05-2.03)

0.40(0.16-0.90)

53.2%

> 1

0.07(0.02-0.21)

0.97(0.87-1.00)

1.15(0.97-1.4)

0.21(0.03-1.23)

47.6%

Having at least 3 out of 5 predictors appears to be the optimal threshold for choosing the cervical traction as an intervention.

Having fewer than 2 predictors might indicate a sub-group who would preferentially benefit from a different intervention (e.g.) pt had 1/5 predictor variables, the post-test probability of success with cervical traction and exercise is only 47.5%, less than a chance.

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